An examination of a psychological skills intervention in an exercise program for overweight and obese individuals

Obesity may be defined as a state in which an individual has accrued an excess amount of body fat that may be dangerous for one’s overall health (CDC, 2015; Flegel, Carroll, & Ogden, 2012). One treatment option for obesity is bariatric surgery, which has been found to be effective when a large amount of weight loss is necessary (ASMBS, 2015). Physical activity participation has also been found to be a viable adjunctive treatment for weight management, decreasing disease risk, and improving overall quality of life for those who undergo bariatric surgery (Coen & Goodpaster, 2016; Hunt & Gross, 2009; Steele, Cuthbertson, & Wilding, 2015). Current research has demonstrated the use of Social Cognitive Theory (SCT) intervention in conjunction with exercise to increase self-efficacy while promoting exercise adherence and behavior change (Annesi & Gorjala, 2010b). However, there is a gap in literature on physical activity combined with behavioral intervention as a means of weight loss and lifestyle change for these individuals. The Bariatric Exercise Lifestyle Transformation (BELT) program is designed to help overweight and obese individuals adopt a physically active lifestyle by learning to exercise safely and effectively. Little research has been conducted regarding the use of psychological skills to increase positive self-perceptions, self-efficacy for exercise and the transition from the 16-week BELT program to lifestyle physical activity. Therefore, the Following a Lifestyle of Wellness (FLOW) program has been developed as the behavioral component of the BELT program and includes 16-weeks of psychological skills education and practice. FLOW is based on SCT (Bandura, 2004), and includes psychological and behavioral strategies designed to increase self-efficacy and the motivation to maintain a healthy lifestyle, as well as identifying the means to overcome potential barriers and avoid relapse. This study examined the effectiveness of the FLOW intervention aimed at increasing self-efficacy and positive self-perceptions while encouraging physical activity maintenance in a bariatric population, and explored the practicality of implementing the FLOW intervention into the existing BELT program. As part of a feasibility study, 11 participants (10 females and 1 male) completed the FLOW program. A variety of data sources were used to assess the effectiveness of the program including self-report questionnaires, intervention evaluations, and semi-structured interviews. Results indicated participants enjoyed the program and felt an increased sense of confidence and readiness to continue with a physically active lifestyle upon program graduation. Interviews indicated that individuals believed the FLOW program was effective for increasing positive self-perceptions, learning psychological skills necessary for behavior change, and improving motivation to exercise. The most effective psychological skills sessions were found to be goal setting, future preparation and planning, and stress management. Participants noted the support and accountability from the program facilitator enhanced their experience, and suggestions for improvement were also provided. This information can be used to improve the FLOW program moving forward. The findings of this study will not only benefit the existing BELT program, but serve as foundational for the development of similar programs in other bariatric and clinical settings